Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon‐expandable and self‐expanding valves

Abstract

Background Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to higher mortality and major complications. No comparison between balloon‐expandable (BEV) and self‐expanding valves (SEV) regarding drop platelet count (DPC) has been reported to date. The objectives of this study were to analyze the differences in DPC between BEVs or SEVs and their prognostic implications in clinical outcomes. Methods We retrospectively analyzed patients undergoing TAVI. Platelet counts after TAVI were collected. Two groups were created: DPC ≤ 30% and DPC > 30%. VARC‐2 criteria were used to define outcomes. Results Study population was composed of 195 patients (age 77.5 ± 6.7, 57.4% males). All of them but one experienced DPC (mean DPC 31.9 ± 15.3%). DPC was significantly higher among the patients treated with BEV compared to those treated with SEV (36.3 ± 15.1% vs 27.7 ± 14.4, P < 0.001). After multivariate analysis, the use of BEV was independently associated with a higher rate of DPC > 30% (67.4% vs 36.0%; OR 3.4; 95% CI, 1.42‐8.16). At 30 days, the DPC > 30% was associated with a higher rate of life‐threatening/major bleeding, major vascular complications, in‐hospital sepsis and mortality. At one year, there were no statistically significant differences in the mortality rate between groups (6.35% vs 10.0%, HR 1.54; 95% CI, 0.56–4.25). Conclusions In this study, the use of BEV was associated with a higher risk of DPC after TAVI. A DPC rate > 30% was associated with an increased risk of major complications at 30 days.

Predictor and Mid-Term Outcome of Clinically Significant Thrombocytopenia After Transcatheter Aortic Valve Selection

“…This result is consistent with previous studies. 5,6 These studies revealed that differences in TAVI valves affected DPC severity. However, the nadir platelet count was not considered in those studies.…”

“…Only a few studies have been reported in which the use of balloon-expandable valves was associated with a greater decrease in post-procedural platelet count than the use of self-expanding valves. 5,6 The purpose of the present study was to investigate the frequency of TAVI-related thrombocytopenia and its predictors, especially with regard to the procedural access site and TAVI device selected. The mid-term clinical impact of TAVI-related thrombocytopenia was also examined.…”

“…Previous studies have demonstrated that thrombocytopenia occurring early after TAVI was associated with poor outcomes. [1][2][3][4][5][6] Therefore, it is important to evaluate the predictors of thrombocytopenia after TAVI.…”

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

“…[59][60][61][62][63][64] Finally, a periprocedural thrombo-inflammatory state and reduced platelet turnover in the older patient may act synergistically, resulting in transient thrombocytopenia in 69-87% of TAVI patients, signalling severe impairment of general homeostasis. [65][66][67] Gastrointestinal bleeding associated with aortic stenosis is due to the shear stress and flow turbulence across the stenotic aortic valve, which may cause the cleavage of high-molecular-weight multimers of von Willebrand factor, a coagulation protein responsible for haemostasis.…”

Predictors of Thrombocytopenia After Transcatheter Aortic Valve Implantation: A Retrospective Study at a Single Japanese Center

“…Transcatheter aortic valve implantation (TAVI) is used to treat high-risk patients with severe aortic stenosis [1][2][3]. However, TAVI-related thrombocytopenia is common [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], with platelet counts decreasing to < 100 × 10 3 /µL in more than one-third of patients who undergo TAVI [4,5]. Previous studies have shown that the nadir platelet count is approximately 50-60% of the baseline value, occurs on postoperative day 2-3, and begins to recover after postoperative day 5 [4,[6][7][8][9].…”